Haemorrhoids are among the most common — and most "embarrassing" — conditions. The good news is that in most cases they are managed without surgery. The key is the grade and the intensity of symptoms. Below we explain when conservative treatment is enough, what the in-between options are, and when surgery is genuinely needed — with one important warning about blood in the stool.

What haemorrhoids are

Haemorrhoids are normal vascular "cushions" at the end of the anal canal. They become a problem when they enlarge and cause symptoms. They are divided into internal (higher up, usually painless, with bleeding as the main symptom) and external (lower down, which can hurt, especially if they thrombose).

The grades of internal haemorrhoids

Treatment depends largely on the grade:

  • Grade I: do not prolapse; usually bleeding only.
  • Grade II: prolapse on defecation but return on their own.
  • Grade III: prolapse and need to be pushed back manually.
  • Grade IV: are permanently prolapsed and do not return.

When conservative treatment is enough

For lower grades (I–II) and mild symptoms, the first line is almost always conservative:

  • More fibre and water, so that stools become soft — this alone relieves many patients.
  • Avoiding prolonged sitting and heavy straining on the toilet.
  • Topical creams or suppositories for relief, and warm sitz baths.
  • Regular physical activity.

Many episodes settle with these measures within a few days to weeks.

Minimally invasive options

When symptoms persist despite conservative treatment — often at grade II–III — there are office procedures, without general anaesthesia, such as rubber band ligation and sclerotherapy. They are effective, with quick recovery, and represent an intermediate step before surgery.

When surgery is needed

Surgical treatment (for example haemorrhoidectomy or other modern techniques) is mainly considered when:

  • There are grade III–IV or large, mixed haemorrhoids.
  • Symptoms do not settle with conservative treatment or office procedures.
  • There is recurrent bleeding or a thrombosed, painful external haemorrhoid.

The choice of technique is individualised.

Caution: blood is not always "haemorrhoids"

This is perhaps the most important point of the article. Rectal bleeding is often "automatically" attributed to haemorrhoids — yet the same symptoms can come from other, more serious causes, such as polyps or colorectal cancer. For this reason bleeding — especially if it is new, persistent, changes in character or is accompanied by a change in bowel habits, weight loss or anaemia — needs medical assessment, not self-diagnosis.

How to reduce flare-ups

  1. A fibre-rich diet and enough water.
  2. Do not delay or "strain" on the toilet; avoid prolonged sitting.
  3. Regular movement and exercise.
  4. Treat constipation or diarrhoea early.

Related: Condition page: Haemorrhoids · Anal fissure

Do haemorrhoids go away on their own?

Mild episodes often settle with more fibre, fluids and avoiding heavy straining on the toilet. If symptoms persist or recur, a medical review is needed.

Are haemorrhoids dangerous?

They are usually not dangerous, although they can be bothersome. The main risk is wrongly attributing to haemorrhoids a bleed that is actually due to another cause.

Is treatment painful?

Office procedures (such as rubber band ligation) are usually well tolerated. Surgery may involve post-operative discomfort for a few days, controlled with pain relief.

Does blood on the paper definitely mean haemorrhoids?

No. The same symptom can have other, more serious causes. Rectal bleeding needs medical assessment, especially if it is new, persistent or changes in character.

How can I prevent them?

With a fibre-rich diet, enough water, regular activity, avoiding prolonged straining on the toilet and treating constipation early.